Spinal cord injuries (SCI) are incredibly damaging, and they can change the course of a person’s life forever. In the U.S. alone, every year, roughly 17,700 individuals acquire an SCI. When it comes to airway management of patients with SCI, there are many considerations providers must keep in mind related to the impact of SCI on airway function, and the connection between the airway, cervical column and spinal cord.
Injury types and symptoms
There are two types of spinal cord injuries, complete and incomplete, and they are associated with different causes, symptoms and features. Complete SCIs cause total paralysis below the level of injury, impacting both sides of the body, and sometimes causing quadriplegia, or paralysis of all four limbs, or paraplegia, paralysis of the lower half of the body.
Incomplete SCIs result in partial functioning remaining on one or both sides of the body. The individual’s brain and body can still communicate along certain pathways after incomplete SCIs.
The injury symptoms individuals experience depend on the type of SCI (complete or incomplete) they’ve had and the location of the damage. Some common SCI symptoms include:
- Weakness in the arms or legs
- Decreased sensation in the arms or legs
- Loss of bladder or bowel control
- Severe pain or pressure in the neck or back
- Unusual lumps along the spine
- Difficulty breathing
Injury factors that impact the airway
The airway is closely connected to the spinal cord and cervical column, and SCI patients often encounter respiratory challenges as a result of their injuries. The extent of the airway complications depends on the height and completeness of the spinal cord damage. The higher up the injury is on the spinal cord, the more closely and severely it impacts airway health and functioning.
Patients with high cervical injuries often experience loss of or weakness in diaphragm function depending on the severity of injury damage, and some require tracheostomies or ventilators to assist with breathing.
With incomplete cervical injuries the degree of diaphragm weakness depends on the extent and location of injury damage.
Performing airway management on SCI patients
The first priority EMS providers should focus on when performing airway management on SCI patients is securing the airway while maintaining cervical immobilization. This may be challenging if the patient is in transport or in a vehicle and not breathing. Before getting started, though, it’s important to weigh the consequences of moving a patient with an SCI against the need for immediate airway intervention, as moving an SCI patient improperly can carry significant safety risks.
When treating unresponsive patients, one provider should secure airway patency while another helps to maintain C-spine alignment and remove the patient carefully onto a backboard or fully body splint. After fully immobilizing the patient and securing their airway and breathing, providers should continue their assessment of the patient’s SCI and associated airway complications, paying close attention to clues that indicate the height of the injury and whether it is complete or incomplete.
Depending on the injury, airway suctioning may be essential for aiding patients in coughing or swallowing effectively. Keeping a portable suction unit on-hand during patient movement and transport is the best way for providers to remain prepared for any airway challenge or emergency.
Treating SCI patients can be incredibly stressful and overwhelming at times, but with the right knowledge and preparation, responders will be equipped to handle any SCI airway management scenarios they encounter and provide the safest, most effective care possible for their patients.
Read this blog to learn more about airway issues in the SCI patient.
